Visual Vestibular Mismatch in Work-Related Vestibular Injury

Abstract

To define and investigate the symptom set known as visual-vestibular mismatch and analyze its nature and occurrence in two groups of patients referred for dizziness. Prospective study of two groups of sequentially referred patients complaining of dizziness, imbalance, or both. A tertiary and quaternary care ambulatory referral center. Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures. Standard vestibular assessment including computerized dynamic posturography was carried out on all patients. A series of questions was designed to quantify patients' complaints of symptoms of visual-vestibular mismatch, and patients were scored according to their yes/no answers to the five questions. Results of traditional vestibular tests were correlated with the answers to the questions. Computerized dynamic posturography and electronystagmography results were compared between both symptomatic and nonsymptomatic patients and also between patients who had traumatic and nontraumatic causes of their symptoms. We found no correlation between test results and the presence of visual-vestibular mismatch symptomatology. There does seem to be a connection between the presence of motion sickness symptomatology and the development of visual-vestibular mismatch symptoms. Although visual-vestibular mismatch is of vestibular origin, it is discernible only after obtaining a careful history. It is a genuine symptom set of vestibular origin, and there is a certain group of patients who are more sensitive to this symptom set and who are often debilitated by its presence.